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Old 08-09-2013
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Correct Answer OB/gyn question #9

A 59 y/o woman comes to the office because of vaginal pain during intercourse and a persistent vaginal itch. Her LMP was at 51 years of age. She takes thyroxine for hypothyroidism. She has no other medical problems and no known drug allergies. A pelvic examination is performed that demonstrates the vaginal mucosa to be pale with no rugae present. The vagina is dry with no discharge present. A K+ Hydroxide and normal saline wet preparation are negative for trichomonas, clue cells and pseudohyphae.
The most appropriate next step in management is.
A. Explain that no treatment is available.
B. Refer the pt for sexual counseling.
C. Treat with clotrimazole vaginal cream.
D. Treat with estrogen vaginal cream.
E. Treat with metronidazole vaginal cream.
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Old 08-09-2013
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Quote:
Originally Posted by XpaezX View Post
A 59 y/o woman comes to the office because of vaginal pain during intercourse and a persistent vaginal itch. Her LMP was at 51 years of age. She takes thyroxine for hypothyroidism. She has no other medical problems and no known drug allergies. A pelvic examination is performed that demonstrates the vaginal mucosa to be pale with no rugae present. The vagina is dry with no discharge present. A K+ Hydroxide and normal saline wet preparation are negative for trichomonas, clue cells and pseudohyphae.
The most appropriate next step in management is.
A. Explain that no treatment is available.
B. Refer the pt for sexual counseling.
C. Treat with clotrimazole vaginal cream.
D. Treat with estrogen vaginal cream.
E. Treat with metronidazole vaginal cream.
D. Estrogen treatment
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Old 08-09-2013
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ans D........
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Old 08-09-2013
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D.............
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Matched!!!
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Old 08-10-2013
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The correct answer is D. This woman is suffering from vaginal atrophy secondary to her menopause, the best treatment available so fat is vaginal estrogen cream, this treatment can be given even if she has risk for breast or endometrial cancer because the estrogen is absorbed locally and the little level that can be absorbed systemically is so so low is not even significant. Treatment should be instituted not only because of her dyspareunia, but because she is at risk for candida vulvovaginitis.
Other common used methods are topical lubricant and sexual intercourse (it has been shown to actually increase the vaginal gland secretion of mucus that is good for the vagina)

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